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Table of Contents
CLINICAL IMAGE
Year : 2022  |  Volume : 19  |  Issue : 1  |  Page : 62-63

Transverse vaginal septum causing hematometrocolpos


Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission10-Aug-2021
Date of Decision08-Sep-2021
Date of Acceptance10-Sep-2021
Date of Web Publication26-Oct-2021

Correspondence Address:
Priya Singh
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_95_21

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How to cite this article:
Singh P, Singh SP, Gupta V. Transverse vaginal septum causing hematometrocolpos. Apollo Med 2022;19:62-3

How to cite this URL:
Singh P, Singh SP, Gupta V. Transverse vaginal septum causing hematometrocolpos. Apollo Med [serial online] 2022 [cited 2022 May 22];19:62-3. Available from: https://www.apollomedicine.org/text.asp?2022/19/1/62/329357

A 20-year-old female presented with primary amenorrhea and cyclical lower abdominal pain. Clinical and pelvic examination was completely normal with the presence of normal secondary sexual characteristics. Ultrasonography of the pelvis revealed echogenic fluid collection in the proximal vagina, cervix, and uterus with a normal appearance of bilateral ovaries. These findings were suggestive of hydro or hematometrocolpos. Moreover, the possibility of imperforate hymen, transverse vaginal septum, lower vaginal atresia, and hemi-vaginal atresia was kept. For further evaluation, a magnetic resonance imaging (MRI) of the pelvis was ordered. MRI [Figure 1] and [Figure 2] revealed upper vagina, cervix, and lower uterus were markedly distended with T1 isointense and T2 hyperintense cystic content representing hematometrocolpos. A 2-mm thick hypointense septum or membrane was seen in the upper one-third vagina, leading to obstruction and proximal collection of blood. Lower one-third of the vagina was collapsed. Bilateral ovaries were normal. No other genito-urinary abnormality was present. Thus, a diagnosis of transverse vaginal septum causing hematometrocolpos was made. Septum was although thin but approximately 4 cm from introitus; therefore, an abdomen-perineal approach using laparotomy was used for complete surgical resection of the septum.[1] Laparoscopic resection is a recent method for resection of such type of transverse vaginal septum, but requires expertise.[1]
Figure 1: Magnetic resonance imaging. (a) T2-weighted sagittal image, (b) T1-weighted coronal image, (c) T2-weighted fat saturated coronal image shows marked distention of upper vagina, cervix, and lower uterus with T1 isointense and T2 hyperintense cystic content representing hematometrocolpos (blue arrow). A thick hypointense septum or membrane (white arrow) is present in the upper one-third vagina, leading to obstruction. Note normal and collapsed distal two-third of the vagina (yellow arrow)

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Figure 2: Magnetic resonance imaging. T2-weighted fat saturated axial images shows (a) normal distal vagina (yellow arrow) and (b) proximal vagina distended with hemorrhagic contents showing T2 shading (blue arrow)

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A transverse vaginal septum is a rare congenital uterovaginal anomaly with a reported prevalence of 1 in 30,000 to 1 in 84,000 females.[2] The transverse vaginal septum has been described in the upper third in 46% of patients, middle third in 40% of patients, and lower third 14% in patients.[3] The thickness of the septum can be variable, with a thicker septum usually located toward the cervix. They can be associated with other urogenital anomalies. It needs to be differentiated from imperforate hymen, which is generally in the lower third of the vagina, thin, and transilluminate on vaginal examination. Early recognition of this obstructive vaginal lesion is essential to preserve fertility and prevent complications from retrograde tubal reflux and subsequent endometriosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jain N, Gupta A, Kumar R, Minj A. Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly. J Hum Reprod Sci 2013;6:74-6.  Back to cited text no. 1
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2.
Deligeoroglou E, Makrakis E, Creatsas G. Obstruction of the female genital tract because of vaginal septum in adolescence. J Gynecol Surg 2001;17:49-56.  Back to cited text no. 2
    
3.
Deligeoroglou E, Iavazzo C, Sofoudis C, Kalampokas T, Creatsas G. Management of hematocolpos in adolescents with transverse vaginal septum. Arch Gynecol Obstet 2012;285:1083-7.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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